Conventional Endotracheal Tube Research Articles

Comparing Artificial Intelligence-Based Versus Conventional Endotracheal Tube Monitoring Systems in Clinical Practice.

Endotracheal tube dislodgement is a common patient safety incident in clinical settings. Current clinical practices, primarily relying on bedside visual inspections and equipment checks, often fail to detect endotracheal tube displacement or dislodgement promptly. This study involved the development of a deep learning, artificial intelligence (AI)-based system for monitoring tube displacement. We also propose a randomized crossover experiment to evaluate the effectiveness of this AI-based monitoring system compared to conventional methods. The assessment will focus on immediacy in detecting and handling of tube anomalies, the completeness and accuracy of shift transitions, and the degree of innovation diffusion. The findings from this research are expected to offer valuable insights into the development and integration of AI in enhancing care provision and facilitating innovation diffusion in medical and nursing research.

Laryngeal Mask Airway as an Appropriate Option in Pediatric Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis

ObjectiveTo elucidate the safety and effectiveness of laryngeal mask airway (LMA) use in pediatric patients undergoing laparoscopic inguinal hernia repair. MethodsStudies were searched on the PubMed, EMBASE, and Cochrane Library databases. Only randomized controlled trials (RCTs) were included. Primary outcomes were major perioperative respiratory adverse events (PRAEs), namely laryngospasm, bronchospasm, desaturation, and aspiration. Secondary outcomes were minor PRAEs, anesthesia time, and recovery time. A meta-analysis was performed to calculate risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (CI) by using random effects models. ResultsIn total, 5 RCTs comprising 402 patients were included. Regarding major PRAEs, laryngospasm (RR: 0.43, 95 % CI: 0.12 to 1.47; p = 0.18), bronchospasm, and aspiration all demonstrated no difference between the laryngeal and endotracheal groups. Desaturation exhibited a trend, but this trend was not sufficiently supported with statistical evidence (p = 0.09). For minor PRAEs, fewer patients experienced incidence of cough after laryngeal mask use (RR: 0.27, 95 % CI: 0.11 to 0.67; p = 0.005). Other PRAE, namely hoarseness (p = 0.06), sore throat (RR: 1.88, 95 % CI: 0.76 to 4.66; p = 0.18), and stridor, did not differ between the 2 groups. Additionally, both anesthesia time (WMD: −6.88 min, 95 % CI: −11.88 to −1.89; p < 0.00001) and recovery time (WMD: −4.85 min, 95 % CI: −6.51 to −3.19; p < 0.00001) were shortened in the LMA group. ConclusionLMA used in pediatric laparoscopic inguinal hernia repair demonstrated no greater safety risks than endotracheal tube intubation did. Thus, anesthesiologists may shift from conventional endotracheal tube use to LMA use. Moreover, anesthesia and recovery times were shortened in the LMA group, which resulted in more efficient use of the operating room. Because of these benefits, LMA could be an appropriate option for pediatric patients undergoing laparoscopic inguinal hernia repair. Level of Evidence:Treatment Study, LEVEL III

Micropipette tip intubation in rats as a replacement for conventional endotracheal tube intubation.

Endotracheal intubation is often necessary in the course of animal experiments, especially in craniofacial surgery. However, endotracheal intubation can be a major burden in this context. The authors performed simple and cost-saving method using a 200 μL yellow micropipette tip, and the success of this method was demonstrated by X-ray and autopsy. We used a total of 30 rats. After the rats were fixed with a plaster, the trachea and vocal cords were visualized with the tongue pulled back. Under direct visualization of the vocal cords, a curving micropipette tip was advanced into the trachea. This method can be learned quickly and applied successfully by general experimenters. We successfully intubated all 30 rats without any complications. The success rate of micropipette tip intubation was 100%. This procedure was performed by one experimenter within 2 to 3 minutes after induction of anesthesia. We demonstrated its superiority by X-ray and autopsy. Herein, we describe endotracheal intubation of rats using micropipette tips. To the best of our knowledge, this method is novel and represents the simplest and most efficient means of intubation in rats, providing an alternative to conventional endotracheal intubation.

High frequency jet-ventilation anaesthesia in patients with laryngeal patholog

Airway management in laryngeal surgeries is a challenge for an anesthesiologist due to sharing of airway with a surgeon. The airway is often compromised with potential for perioperative worsening. Introduction of high-frequency jet ventilation (HFJV) in 1970 offered a new modality to secure airway in the laryngology procedures, excluding the disadvantages of classic tracheal intubation. HFJV is characterized by delivery of small tidal volumes (1–2 ml/kg) from a high-pressure jet at supraphysiological frequencies (1–10 Hz) followed by passive expiration. At ENT clinic of “T.Moșneaga” hospital HFJV are used for several years. Applied via supraglottic aproach, HFJV is first choice in patients with severe laryngeal obstruction, lesions of posterior glottic regions, a lot of pacients being suffering of laryngeal papillomatosis. This method can be safely used in microlaryngeal surgery, excluding a lot of serious intraoperative complications, esspecially combustions of conventional endotracheal tubes. Till now, there are not reported complications in our local practice of HFJV.

Comparative Analysis of Peak Air Pressure and Oxygen Flow between Conventional and Modified Endotracheal Tube for Retromolar Intubation (PUNTUBE)- An In Vitro Study.

In conventional practice for retromolar intubation, endotracheal tube (ET) is bent. This leads to compression of the inner diameter of the tube which in turn reduces airflow. Furthermore, conventionally ETs are stabilised in position using inflated tracheal cuff. Elastic sticky tapes around the exit pose hindrance for surgical procedures on the face. Surgical manipulation and maxillomandibular fixation may lead to compression, damage or accidental extubation of ET. We have developed a modified ET dedicated to retromolar intubation with innovative means for tube stabilisation to solve these problems. To study the efficacy of the tube, a comparative in vitro study was done on mannequins. Null hypothesis of no change in air pressure and oxygen concentration in bent conventional ET versus modified ET was formulated. Comparison was done on the basis of the peak air pressure (PEP) and oxygen concentration, which was checked using air-gas monitor. The mean PEP was found to be 24.29 psi with standard deviation (SD) of 9.54 in sequentially bent conventional tube. This was found to be only 10.35 psi with SD of 3.22 in modified ET. Oxygen delivery was found to be 3.96 L/min in bent conventional tube, which was 5.22 L/min in modified tube. Both the findings were statistically significant. Modified retromolar tube (PUNTUBE) has been found to be efficient in maintaining low PEP while delivering more oxygen as compared to bent conventional tube. Novel mode of tube stabilisation in the form of PUNSTAB is an easy and effective way of tube stabilisation.

CODE BLUE in a patient with tracheal stent: Are we fully equipped?

Sir, Airway stents have long been used to maintain luminal integrity of compromised airway in case of obstruction and malignancy.[1] The complications associated with airway stent placement are malposition, haemorrhage, airway rupture during placement, migration, impaction, formation of granulation tissue, and stent fracture.[2] We present here a challenging case of an airway emergency in a patient with a tracheal stent inserted for a malignancy. A 29-year-old woman diagnosed with adenoid cystic carcinoma of trachea 2 years back had undergone debulking of tumor, tracheal stenting with a metallic stent, and chemo-radiotherapy elsewhere. On the second day of admission, CODE BLUE was activated in view of acute onset biphasic stridor, with air hunger and low oxygen saturation. Despite resuscitation measures, the patient had persistent tachycardia, tachypnea, and hypoxia with non-rebreathing mask (15 L/min of O2). A review of Computed Tomography (CT) neck revealed a tracheal narrowing 1.7 cm distal to vocal cords with narrowest diameter of 6 mm [Figure 1a], complicating an imminent intubation for the patient. She was pre-oxygenated with a non-invasive ventilation mask. Intravenous boluses of fentanyl 75 mcg, muscle relaxant (suxamethonium 100 mg) was given and intubated with a 5.0 mm ID cuffed endotracheal (ET) tube through direct laryngoscopy. A chest x-ray confirmed the position of the ET tube but it fell short of bypassing the tracheal stent, which was reflected in decreased tidal volumes and increased peak pressure. As the length of the 5.0 mm ET tube (23 cm) was not enough to bypass the stent, we had to increase the length by rail roading another 6.5 mm ID tube at the distal end, after removing the connector [Figure 1b]. This step significantly improved the tidal volumes (350-400 ml) without much rise in peak pressure with marked improvement in the oxygenation of patient in the blood gas analysis. Patient underwent bronchoscopic biopsy and excision of mass around the stent after putting on veno-venous extracorporeal membrane oxygenation for oxygenation. Post-procedure ET tube was removed after suctioning and intubated with 7.0 mm ID ET tube for postoperative ventilation and eventually extubated.Figure 1: (a) image showing CECT neck with tracheal stent in situ. (b) image showing the proximal end of 6.5 mm ID tube is cut and railroaded over 5.0 mm ID tube to increase the lengthSecuring airway in an in-hospital CODE blue needs quick thinking and swift action. This case highlights a unique situation where a tracheal stent precluded a “conventional intubation.” A tracheostomy could damage the stent and a supraglottic airway device risked aspiration.[3] A fibre-optic bronchoscope is essential and the best available option to ensure correct position of the tube within the stent or just above the stent. It can also avoid stent-related complications but is not readily available everywhere.[4] No formal guidelines are available in terms of airway management with tracheal stents in situ. A literature search also revealed paucity of data with regard to management in similar case scenarios. Microlaryngeal surgery (MLS) tubes can be made available in the CODE BLUE kits anticipating such scenarios, as they are longer than conventional ET tubes with same internal diameter.[5] This case though uncommon highlights the need to incorporate airway management in cases of tracheal stents as part of our teaching curriculum. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial.

The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change. To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation. In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH2O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH2O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured. The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH2O) than in the cylindrical cuff (25.5 ± 0.8 cmH2O) after head and neck extension (P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) (P < 0.001). The incidence of postoperative airway complications was comparable between two groups. After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.

Airway obstruction by a folding metal rod within a Reinforced Oral tracheal Tube: Case Report

The Reinforced Orotracheal Tube (ROT) is an airway device for intubation that allows invasive ventilation during general anesthesia. The ROT differs from a Conventional Endotracheal Tube (CET) by the presence of a stainless-steel spiral, which strengthens the wall and hinders collapse. The ROT can be used when there is a risk of obstructing the flow of gases through compression or elbowing of the endotracheal tube, during orofacial surgical procedures, neurosurgery or in non-supine surgical positions under deep general anesthesia. The metallic spiral, which reinforces the lumen of this endotracheal tube, is subject to damage and deformities that can compromise the permeability of its lumen. The ROT should be used only during the surgical procedure under deep general anesthesia. If there is a need for the permanence of orotracheal intubation in the postoperative period of patients referred to the intensive care unit, the ROT should be replaced by the polyvinyl chloride CET, given the risk of damage to the ROT due to bites with fracture of the metal rod and obstruction by folding, as in this case, which will be reported below. The rarity of similar reports in the literature and the severity of obstruction of an endotracheal tube causing severe hypoxemic disorders, guided the objective of this case report, which aims to guide preventive and resolving measures, in addition to including to the list of diagnoses of causes of acute obstructions of an endotracheal tube. Keywords: Airway obstruction; Armoured tube; intubation: mechanical ventilation.

Adverse Respiratory Events After Removal of Laryngeal Mask Airway in Deep Anesthesia Versus Awake State in Children: A Randomized Trial.

BackgroundThe advent of the laryngeal mask airway (LMA) has reduced respiratory events in comparison to the conventional endotracheal tubes. Any manipulation under a light plane of anesthesia predisposes to increased airway sensitivity followed by adverse events. The reduced airway sensitivity in the deeply anesthetized state makes LMA removal feasible. In the past, the respective advantages and disadvantages of extubation in two planes of anesthesia have led to conflicting results. The primary objective of this study is to compare the incidence of adverse respiratory events at the time of LMA removal, in deeply anesthetized and awake groups. Our secondary objective was to record the management of complications.Materials and methodsWe conducted a prospective randomized control trial in 106 American Society of Anesthesiologists (ASA) I and II patients undergoing lower umbilical surgeries over a period of one year. The demographic details and intraoperative and postoperative variables, i.e., airway obstruction, laryngospasm, peripheral oxygen desaturations, cough, straining and vomiting, along with corrective measures were recorded by the primary research assistant in both groups. Regarding the management of peripheral oxygen desaturation (less than 90%), airway obstruction, and laryngospasm, 100% fractional inspired oxygen support and chin lift/jaw thrust were used.ResultsThe average age was 32.58±15.81 months. The demographic characteristics of the patients were not significant between the two groups. The rate of adverse respiratory events like laryngospasm and airway obstruction was relatively high in the deep group but not statistically significant between the groups. A total of 7 (6.6%) patients had laryngospasm, 21 (20%) had airway obstruction, 16 (15%) had a cough and 11 (10%) patients had observed peripheral oxygen desaturation (less than 90%) between both groups. ConclusionWe concluded that adverse respiratory events could happen in both awake and deep planes of anesthesia after the removal of LMA in children. Furthermore, both techniques have an acceptably low frequency of complications, and it does not affect the current clinical practice.

The Effect of Continuous PEEP Administration during Surfactant Instillation on Cerebral Hemodynamics in Intubated Preterm Infants: A NIRS Study.

There is an ongoing debate about the best and comfortable way to administer surfactant. We hypothesized that uninterrupted respiratory support and continuous PEEP implementation while instilling surfactant via endotracheal tube (ETT) with side port will result in higher regional cerebral tissue oxygenation (rcSO2) and the alterations in cerebral hemodynamics will be minimal. Preterm infants who required intubation in the delivery room and/or in the first 24 hours of life with gestational age <32 were enrolled. Patients were intubated either via conventional ETT or ETT with side port (Vygon) with appropriate sizes. Following neonatal intensive care unit admission a near-infrared spectroscopy (NIRS) probe was placed on the forehead and each infant was started to be monitored with NIRS. In conventional ETT group, patients separated from the ventilator while surfactant was instilled. In ETT with side port group, respiratory support was not interrupted during instillation. Heart rate, oxygen saturation, rcSO2, cerebral fractional tissue oxygen extraction (cFTOE), and blood pressures were recorded. A total of 46 infants were analyzed. Surfactant was instilled with conventional ETT in 23 and ETT with side port in 23 infants. Birth weights (1,037 ± 238 vs. 1,152 ± 277 g) and gestational ages (28 ± 2.3 vs. 29 ± 1.6 weeks) did not differ between groups. During instillation of surfactant, rcSO2 levels [61.5 (49-90) vs. 70 (48-85)] and cFTOE levels 0.28 (0.10-0.44) vs. 0.23 (0.03-0.44)] were similar (p = 0.58 and 0.82, respectively). Interruption of respiratory support during surfactant instillation did not significantly alter the cerebral tissue oxygenation. These results did not support our hypothesis and should be confirmed with further studies. · Monitoring intracerebral oxygenation changes during surfactant administration with NIRS is feasible.. · The surfactant administration method does not significantly alter the cerebral oxygenation.. · Surfactant administration itself rather than the method caused a transient drop in cerebral NIRS readings..

Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck: A randomized clinical trial.

Background:Endotracheal tube (ETT) with a tapered-shaped cuff had an improved sealing effect when compared to ETTs with a conventional cylindrical-shaped cuff. Positional change and neck movement typically displace an ETT and change the intracuff pressure. The aim of the current study was to compare the ETT cuff pressure in the TaperGuard ETT vs the conventional ETT after a change from the supine, neutral position to the extension of the neck and semi-Fowler position for thyroid surgery.Methods:This prospective, randomized clinical trial included 50 patients undergoing thyroidectomy. Patients were randomly allocated into one of the 2 groups: tracheal intubation with the TaperGuard ETT or with a conventional ETT. The ETT cuff was inflated with air and the ETT cuff pressure was set initially at 20 cmH2O using a calibrated cuff manometer. ETT cuff pressure and distance from carina to ETT tip were measured at supine and semi-Fowler positions with neck extension.Results:After the position change, the ETT tip migrated cephalad and cuff pressure increased in the majority of cases. ETT cuff pressure was significantly higher in the TaperGuard group than the conventional group (28.0 ± 6.6 cmH2O and 22.8 ± 4.5 cmH2O, respectively, P = .001). The degree of cephalad displacement of the ETT tip was comparable between the 2 groups (19.4 ± 6.31 mm in TaperGuard group and 21.9 ± 6.9 mm in conventional group, P = .12).Conclusions:After the position change from supine to hyperextension of the neck, the ETT cuff pressure was higher in the TaperGuard ETT than in the conventional ETT, although the extent of displacement of the ETT was comparable between the 2 groups.

Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes

Background and Objectives Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed.Results IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group.Conclusion IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.

Comparison of Baska Mask and Conventional Endotracheal Tube in Airway Management during Laparoscopic Cholecystectomy: A Randomized Clinical Study

Background: Baska mask has been chosen to secure airway for surgeries under general anesthesia in view of its adaptability during positive pressure ventilation as it moulds accordingly. Aims: Our aim was to compare BASKA mask with Endotracheal tube primarily for hemodynamic changes, and also ease of insertion in terms of number of attempts and time taken for insertion, airway trauma, intraoperative and postoperative laryngopharyngeal morbidity (LPM) occurring in patients undergoing laparoscopic cholecystectomies under general Anesthesia. Methods: A hospital based prospective, randomised comparative clinical study involving60 ASA I and II patients undergoing laparoscopic surgeries under general Anesthesia were randomly divided into 2 groups of 30 each (n=30), either using BASKA mask or ETT. Hemodynamic changes in both the groups were compared, along with number of attempts and time for insertion and laryngopharyngeal morbidities. Results: Hemodynamic fluctuations are less in patients who received Baska mask for their airway management than with endotracheal tube insertion. The number of attempts of insertion and time duration of insertion of Baska Mask (Mean ±SD=13.50±5.49) for airway management were less and with negligible postoperative laryngopharyngeal comorbidities when compared with endotracheal intubation in adult patients undergoing elective laparoscopic cholecystectomy under general anaesthesia with positive pressure ventilation. Conclusion: Baska Mask with its unique anatomy and features is a good alternative to endotracheal tube for airway management in elective laparoscopic cholecystectomies under general anaesthesia with positive pressure ventilation in terms of negligible hemodynamic changes, less number of attempts and reduced mean time duration of insertion, and less laryngopharyngeal morbidities.

The use of USB endoscope (Borescope) as an educational tool and a guide for tracheal intubation − a preliminary report

Background In spite of the presence of multiple video laryngoscopes in the market, financial restrains are present that prevent its routine use in many practices.Methods The endoscope USB camera was inserted alongside with a stylet in a conventional endotracheal tube which could be inserted orally keeping it in midline (7 or 7.5 cuffed oral endotracheal tube), and sterile k-y gel was used to facilitate the insertion of the stylet and/or the borescope. This was used for 25 oral intubations in manikin and oral intubation in 10 patients.Results Oral intubation trials on manikin were done by 25 physicians after their completion of airway course as its last session. All were anesthesiologists except one emergency room physician. A total of 14 (56%) physicians were successful to orally intubate the manikin in the first attempt. Moreover, 10 (40%) physicians were successful to orally intubate the manikin in the second attempt with verbal guidance, except one who needed manual assistance, and one physician was successful to orally intubate the manikin in the third attempt with verbal assistance. The intubated 10 patients were all of Mallampati 1 or 2, where seven were intubated on the first attempt, two on the second attempt, and one failed.Conclusion Borescope can be used as a cheap option for airway management and its training. Randomized studies need to be done for its evaluation compared with other video laryngoscopy devices.

ETView VivaSight single lumen vs. conventional intubation in simulated studies: a systematic review and meta-analysis.

ObjectiveThe ETView VivaSight single lumen airway tube (ETView) is a tracheal tube incorporating a video camera. We carried out a meta-analysis of previous simulation studies by inexperienced personnel to determine if the ETView could improve the success rate of first-attempt intubation.MethodsWe collected data from randomized controlled trials comparing the use of the ETView VivaSight single lumen versus a conventional endotracheal tube in a simulated manikin or cadaver study.ResultsEleven studies (558 participants, 3,254 intubations, and 19 scenarios) were included. The ETView had a significantly higher success rate and shorter insertion time than conventional intubation in both normal airways (with or without chest compression) and in difficult airways. In addition, the ETView demonstrated better results in terms of a higher rate of Cormack−Lehane grade 1 and a lower incidence of dental trauma.ConclusionsInexperienced personnel can insert the ETView more rapidly and with a higher intubation success rate compared with a conventional tube.

ЭТИОЛОГИЧЕСКИЕ АСПЕКТЫ НОСОВЫХ КРОВОТЕЧЕНИЙ И АЛЬТЕРНАТИВНЫЕ СПОСОБЫ ИХ ОСТАНОВКИ

Objective: To study the etiology of epistaxis and to improve the mechanical ways to stop it. Methods: 354 patients with nose bleeding aged 6 months to 78 years were examined from 2,360 people who applied to the urgent ENT Department of the National Medical Center of the Republic Tajikistan, which was 15%. They conducted an otorhinolaryngological examination, evaluation of the general state, finding out the causes of nasal bleeding and all necessary measures to stop it. Results: Out of 354 patients, 339 (95.6%) provided the first emergency care in the urgent ENT Outpatient Department, and 15 (4.2%) hospitalized in ENT Department. Among general and local causes, cardiovascular disease, respiratory infections, chronic atrophic and subatrophic processes of nose mucous were identified. In 297 (83.4%) had a combination of those and other causes. The majority of patients (n=209; 58.5%) suffered from cardiovascular pathology, in particular hypertension and atherosclerosis, in 19 (5.5%) patients the nasal bleeding occurred during the period or after recently suffered acute respiratory infections. Only in 51 (14.4%) patients identified local causes of nasal bleeding, of which 15 patients were hospitalized in the ENT Department. Bleeding was stopped by the anterior nasal tamponade in 6 cases, the anterior and posterior tamponade – in 8 observations, and in one patient, with inefficiency of the posterior and anterior tamponade, ligation of external carotid artery was performed. An alternative method has been used as a rear tamponade for the first time using a device made from a conventional endotracheal tube with an inflatable cuff on the distal end. The method has proven to be more gentle and less traumatic, allowing keeping nasal breathing through the tube. This provides the best quality of postoperative management, and at times accelerates the rehabilitation process. Conclusions: The results show that the causes of nasal bleeding are most often caused by general somatic pathology and only in 14.4% of cases are associated with pathology of nasal cavity. The proposed alternative method of posterior tamponade has shown good results and the possibility of its wide practical application, especially in terms of first aid. Keywords: Epistaxis (nasal bleeding, nosebleed), posterior tamponade, endotracheal tube, hypertension, alternative method

The use of USB endoscope (borescope) to guide nasal tracheal intubation: a pilot study

Background In spite of the presence of multiple videolaryngoscopes in the market, financial restrains prevent their routine use in many clinical practices. Patients and methods The endoscope USB camera was inserted in a conventional endotracheal tube which could be inserted nasally (6.5 or 7 cuffed endotracheal tube). Sterile K-Y lubricating gel was used to facilitate the insertion of the borescope. This was used for nasal intubated in eight patients. Results Nasal intubation trials were done by an experienced physician for eight patients. All eight patients were Mallampati class 1 or 2. One patient was intubated at the first attempt, three were intubated at the second attempt, and one was intubated at the third attempt. There was failure in three cases (secretions and blood). Conclusion Borescope can be used as a cheap option for nasal airway management. Randomized studies need to be done for its evaluation compared with other videolaryngoscopy devices.

A comparative study on prevention of ventilator associated pneumonia using endotracheal tube with or without intermittent subglottic secretion drainage device

Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out the effectiveness of subglottic secretion drainage (SSD) on prevention of ventilator associated pneumonia (VAP) using endotracheal tube with subglottic secretion drainage (ETT-SSD).Methodology: This study was carried out in the 10 beded medical-care Intensive Care Unit (ICU) of BIRDEM Hospital, Dhaka over a period of one and half year, enrolling 48 subjects. Patients expected to require mechanical ventilation (MV) for more than &gt;48 hrs were randomly assigned to one of two groups: one was ventilated with ETT-SSD and the other with conventional endotracheal tube (ETT-C).Results: Primary outcome was the overall incidence of VAP based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes included incidence of early and late onset VAP, duration of MV, duration of ICU stay and in hospital mortality. Microbiologically confirmed VAP occurred in 23 patients, 6 of 24 (25%) in the SSD group and 17 of 24 (70.83%) in the control group.Conclusion: The use of an ETT with intermittent SSD in a patient on MV helps to prevent ventilator associated pneumonia.Bangladesh Crit Care J March 2018; 6(1): 7-15

High-frequency jet ventilation: An invaluable tool for anesthesia in microlaryngoscopy with carbon dioxide laser

Airway management in laryngeal surgeries is a challenge for an anesthesiologist due to sharing of airway with a surgeon. The airway is often compromised with potential for perioperative worsening. Use of carbon dioxide (CO2) laser further narrows the choice of airway device as conventional endotracheal tubes are combustible by CO2 laser. High-frequency jet ventilator is an invaluable tool in anesthetic armamentarium. Apart from laser safety, it offers a nearly tubeless field for the surgeon to excise airway lesions. Careful patient selection, total intravenous anesthesia, and judicious use of anesthetic and vasoactive agents to minimize pressor response are the factors contributing to successful outcome.

Application of a flexible lightwand in percutaneous dilatational tracheotomy

Abstract Purpose By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. Methods Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n = 30) and the withdrawal group (Group W, n = 30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8 cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17 cm at the upper incisors in males and 15 cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. Results Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. Conclusions The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and postoperative anesthesia-related or operative complications compared with the traditional technique of ETT withdrawal to a pre-determined depth.